Monitors continue to find serious problems at Parkland Hospital

In the month of June alone, safety monitors observed 756 instances in which Parkland Memorial Hospital staff violated infection-control standards by failing to use proper hand hygiene.

The monitors also found that “critical vacancies” remain in the troubled psychiatric department, including permanent physicians to oversee mental-health patients seeking emergency care.

And they reported that the hospital still lags behind schedule in efforts to ensure safe supervision of resident doctor trainees.

Those are among several troubling signs in a June report card for the Dallas public hospital as it enters a critical stretch of its regulatory probation. By the end of September, the federal government expects to see evidence that all 400 mandates designed to rid the hospital of dangers to patients are met.

“We thought that Parkland would be further along, and we expect to see improvements,” said David Wright, deputy regional administrator for the U.S. Centers for Medicare & Medicaid Services, the lead agency over Parkland’s reform effort. “We feel a sense of urgency that they need to finish these things earlier.”

While Wright called the persistent problems a concern, he stressed that CMS and the safety monitors are not “at the point where we feel Parkland is unable to attain the goals.” A reassuring step, he said, was Parkland’s recent executive reorganization, which installed new leaders with expertise in hospital turnarounds.

As of June, Parkland had satisfied 281 of 400 federal safety mandates handed down in February, according to the hospital’s synopsis of the latest monthly report card produced by the safety monitors, the Alvarez & Marsal Healthcare Industry Group.

The synopsis cited progress in areas such as enhancing medical-record systems and redesigning the physical layout of the emergency room, where care failures have placed patients in “immediate jeopardy.” The hospital’s infection-prevention policies also were revised.

Debbie Branson, chairwoman of the Parkland board of managers, said she is concerned about missed deadlines and agreed with Wright’s assessment that more — and faster — work must be done to stay on track and show the hospital can stay in compliance.

“We believe we are already in that critical phase in which we must make sustainable the many changes we’ve made in our policies and procedures,” she said in a statement to The Dallas Morning News. “These changes must be engrained in the Parkland culture.”

Six months into Parkland’s survival test — the hospital must prove it can show consistent compliance with regulations before April 2013 or lose federal dollars crucial to its operation — other challenges besides missed deadlines have emerged, stretching the resources of the hospital, health care agencies and safety monitors.

Inspectors with the Texas Department of State Health Services, the licensing agency for Parkland, are wading through a high number of investigations related to potential care breakdowns at Parkland.

The agency already has fielded 117 complaints this year — more than twice the number received in 2011. The majority of the new reports originated with Parkland itself, according to health officials. Last year, it faced criticism from regulators for skirting reporting requirements.

“This is considered a very high number and rate, and we’re working our way through them,” said Carrie Williams, spokeswoman for the health department. “There is an ongoing, heightened level of communication between the state, CMS and the hospital.

Another unforeseen challenge: Alvarez & Marsal has found itself understaffed to meet the demands of policing care and was forced to beef up its monitoring force.

Meanwhile, Parkland’s tab for funding reforms continues to rise. This week, the hospital, which is required to pay Alvarez & Marsal’s expenses, revised its $6 million contract with the group to allow $4 million in additional expenses for the increased staff and other costs. Altogether, Parkland is expected to have spent more than $31 million in reform-related measures by the end of September.

About $9 million of that is tied to hiring consultants to help find solutions to problems and recruit executives to fill positions required under the mandates.

Parkland also has been working with UT Southwestern Medical School, its academic partner that furnishes faculty physicians to oversee resident doctors, to improve supervision of those trainees and provide adequate oversight of the psychiatric department. Regulators have faulted UTSW as failing to provide safe supervision of residents and patients.

In recent months, the hospital and medical school have revised their physician contract to hire and recruit permanent physicians in psychiatric services, according to a May report by the safety monitors.

But the June monitoring report — the latest information available — shows Parkland still hasn’t put those psychiatrists on the job. It also hasn’t implemented an audit system to validate that supervision standards are being followed.

“In our recent meetings with them [Parkland officials], we’re stressing that the focus needs to be not on what we’re going to do to be in compliance but how to infuse safety into employees’ mindsets,” he said. “Washing hands is not just a compliance issue. It’s in the patients’ best interest and that needs to be woven into the culture.”

According to the June compliance report, the monitors observed 756 incidents of “hand hygiene non-compliance.” But that was an improvement, the report noted, over 1,478 such cases in May.

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UT Southwestern Medical Center and Parkland Memorial Hospital are known for their contributions to medical research and public health. But have those accomplishments come at a cost to quality healthcare? The Dallas Morning News investigates patient safety and allegations of lax supervision of doctors in training at the public institutions.